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Clostridioides difficile (Clostridium Difficile)

  • Consider a non-infectious cause for the patient’s symptoms e.g. laxatives.
  • Establish if the patient has diarrhoea (≥3 loose stools [Bristol stool chart 5 – 7] in the last 24h or if ≥3 loose stools is normal for the patient, are the number of loose stools more than baseline?
  • Asymptomatic patients and/or those with an alternative non-infectious cause of their loose stools do not routinely need empirical treatment or laboratory testing.
  • If Clostridioides difficile infection (CDI) clinically suspected, send stool sample.
  • Stop any (non-Clostridioides difficile) antimicrobial treatment in patients with CDI if possible.
  • Review any concurrent gastric acid suppressant therapy and reduce or stop if appropriate.
  • Review and stop any anti-motility agents to reduce the risk of toxic megacolon development.
  • Stop any laxatives for duration of symptoms (remember laxatives may be an alternative cause of the loose stools).
  • Stop any medicines that can be a risk if dehydrated (diuretics, ACE inhibitors, ARBs, NSAIDs, metformin, SLGT2 inhibitors) ie Sick Day Rules.
  • Assess and document symptoms and severity of disease taking into account individual risk factors for patient.
  • Do not routinely treat patients with an equivocal C. difficile result.
  • For patients with a positive C. difficile toxin result, a clinical assessment is required to assess whether the patient meets the CDI case definition. Refer to algorithm on Grampian Guidance (intranet only).
  • Submitting stool samples as a test of cure is not advised as patients may remain C. difficile toxin positive despite clinical improvement.

 

  • For treatment advice in children contact Medical Microbiology.

First Episode – first line option for Adults

Oral Vancomycin 

 

125mg four times daily

 

 

10 days

If there is a delay in obtaining a supply of oral vancomycin then metronidazole can be prescribed initially to prevent a delay in starting treatment. Metronidazole should be substituted with oral vancomycin as soon as availability is resolved to complete a total of 10 days treatment.

First Episode – second line option

Discuss with infection specialist

 

 

 

 

Second Episode

Discuss with infection specialist

Last reviewed: 22 February 2024

Next review: 22 February 2027

Author(s): Specialist Antimicrobial Pharmacists

Version: 1

Author Email(s): gram.antibioticpharmacists@nhs.scot

Approved By: Antimicrobial Management Team

Document Id: AMT_Emp_Primary Care_CDI_1